Provider Demographics
NPI:1235465089
Name:MESBAH, REZA (MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:MESBAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:MESBAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7705 SEVILLE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6570
Mailing Address - Country:US
Mailing Address - Phone:323-275-9977
Mailing Address - Fax:
Practice Address - Street 1:1762 WESTWOOD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5622
Practice Address - Country:US
Practice Address - Phone:310-441-2000
Practice Address - Fax:310-441-2020
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC168003207QA0505X
VA0101248524207Q00000X
NY261697207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine